HJNO May/Jun 2021

56 MAY / JUN 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS ONCOLOGY DIAL GUE COLUMN ONCOLOGY MELANOMA is the most serious formof skin cancer. In the United States, it is the fifthmost common cancer in men and women. As sur- vival rates for people withmelanoma depend on the stage of the disease at the time of di- agnosis, early diagnosis is crucial to improve patient outcome and save lives. MELANOMA SUBTYPES There are four major subtypes of invasive cutaneous melanoma: lentigo maligna, su- perficial spreading, nodular melanoma and acral lentiginous. Uncommon variants in- clude amelanotic melanoma, spitzoid mel- anoma, desmoplastic melanoma and pig- ment synthesizing (animal-type) melanoma. Lentigo maligna melanoma usually arises in areas of sun-damaged skin, particularly on the head and neck. Asymmetry and color variegation are characteristic of superficial spreading melanomas. Nodular melano- mas present a discrete nodule, usually with • Does the patient have a personal or family history of melanoma or other skin cancers? • Does the patient have a history of ex- cessive sun exposure and/or tanning bed use? • Did the patient suffer severe sunburns during their childhood or teenage years? • Does the patient have a cancer-prone syndrome (e.g., familial atypical mole andmelanoma syndrome or xeroderma pigmentosum)? • Is the patient immunosuppressed? • Did the patient receive prolonged pso- ralen plus ultraviolet A (PUVA) therapy? The patient’s phenotypic features associ- ated with an increased risk include: • Light-complexioned phototype. • Red or blond hair. • Light eye color. • Presence of a large number (>50) of me- lanocytic nevi (common nevi). dark pigmentation, although they may be amelanotic. An acral lentiginous melanoma shows the asymmetry and color variegation of typical melanomas. They are distinguished clinically by their location on the palms, soles or nails. CLINICAL DIAGNOSIS The clinical recognition of melanoma and, in particular, of early melanoma may be challenging, even for the most experi- enced dermatologist. It has been estimated that the sensitivity of the clinical diagnosis of experienced dermatologists by the naked eye is approximately 70%. History and risk factors are key to diagnosis. Key questions in history include: • When was the lesion (or a change in a preexisting lesion) first noticed? • Has the lesion changed over time in size, shape, color and/or symptoms (e.g., bleeding, itching)? Protect Your Skin: SAY “NO” TO MELANOMA